Double Crush Syndrome in the Lower Extremity: Is Peroneal Decompression Alone Sufficient?

Introduction: Double crush syndrome (DCS) is defined as multiple sites of compression along a single nerve that results in compound nerve dysfunction. To date, no optimal treatment paradigm has been established for this unique clinical entity. We present a retrospective analysis of 60 DCS patients, with peroneal neuropathy and L5 radiculopathy, that underwent peroneal decompression alone to examine clinical outcomes following peroneal decompression without spinal intervention.

Methods: A retrospective analysis of 100 consecutive patients who underwent peroneal decompression and had a diagnosis of L5 radiculopathy between January 2000 and April 2023 at two quaternary academic institutions was performed. After excluding patients with intraneural ganglion cysts as the etiology of their entrapment and patients who had undergone previous lumbar decompressions, 60 patients were ultimately included in the present analysis. Descriptive statistics of patient demographics, clinical presentation, surgical details and outcomes were performed to assess the efficacy of peroneal decompression without any spinal intervention.

Results: The mean age of patients was 59.30 years old, ranging from 15 to 84 years old. 33 patients had peroneal entrapment on the right, 26 had entrapment on the left, and 1 patient had bilateral entrapment. No patients required subsequent spine surgery following peroneal decompression. Average dorsiflexion strength on presentation was 1.53 out of 5. This improved to 2.57 out of 5 following peroneal decompression. 98% of patients reported pain or numbness, or both, in the lateral leg/dorsal foot on presentation, which decreased to 38% following peroneal decompression.

Conclusion : DCS patients with peroneal neuropathy and L5 radiculopathy achieved significant improvement in dorsiflexion strength and reduced pain/numbness in the L5/peroneal distribution following peroneal decompression alone. While some patients may still require subsequent spinal intervention due to continued symptoms, peroneal decompression should be considered in all such DCS patients as it is far less invasive and can offer significant improvements in symptom burden.